The ObamaCare “risk adjustment” program was designed to support health plans with lots of sick, expensive customers by giving them money from plans with healthier customers. The goal is to help keep insurance markets stable by sharing the “risk” of sicker people and removing any incentive for plans to avoid individuals who need more medical care. Such stability is likely to encourage competition and keep overall prices lower for consumers, while its absence can undermine both and limit coverage choices—the basic principles of the law.
Yet the way the Obama administration has carried out this strategy shows another unexpected consequence of the 2010 health care law. Critics say the risk adjustment program is having a reverse Robin Hood effect—taking money from some plans that are small, innovative or fast-growing, while handing windfalls to some of the industry’s most entrenched players.
Last week, the Department of Health and Human Services (HHS) released 2016 exchange enrollment data through the first two months of the three-month open enrollment period. Although nearly one month of open enrollment remains, the new data generally supports my previous findings. Here are seven things you should know about the new data.
1) 2016 enrollment will likely be at least ten million people below expectations when the ACA was passed
2) People with at least middle class income still largely shunning exchanges
3) Enrollees still skewing older
4) Average advance premium tax credit up 12% from last year
5) 90% of enrollees selected silver or bronze plans
6) 27% of enrollees are new sign-ups, 38% of enrollees are active reenrollees, and 33% of enrollees are automatic reenrollees
7) High auto-enrollment in states not using HealthCare.gov may lead to premium shock
Kentucky’s new Republican governor, Matt Bevin, has notified the Obama administration that he plans to dismantle the state’s ObamaCare marketplace. Bevin, who was sworn in last month, promised to scrap the marketplace, called Kynect, as part of his campaign, but he is now making it official. Bevin’s office said in a statement to WFPL News in Kentucky that having the state run the marketplace is a “redundancy.”
The president is sure to laud ObamaCare at his final State of the Union speech on Tuesday. And no doubt he’ll boast about the 11.3 million people enrolled in an ObamaCare exchange by the end of the year. That may look like “unprecedented demand” to Obama administration officials. But in fact, it’s an ominous sign that ObamaCare is losing what little luster it had in the marketplace. 11.3 million is nothing to celebrate when you consider that at the end of open enrollment last year, the administration claimed that 11.7 million had signed up. By the end of the entire year, that number had been whittled down to about 9 million, of which 8.2 million re-enrolled.
Humana will lose money on its 2016 individual market health plans, and the health insurer expects up to 300,000 will drop their coverage by the end of this year, according to a Securities and Exchange Commission filing released late Friday.
It marks the second investor-owned insurer to publicly disclose the problems it is having with the Affordable Care Act’s insurance markets. UnitedHealth Group has lost millions on the marketplace and said it may exit the exchanges by 2017 if things don’t turn around.
About 1.4 million households that got financial help for health insurance under President Barack Obama’s law failed to properly account for it on their tax returns last year, putting their subsidies at risk if they want to keep coverage. The preliminary figures were released by the IRS late Friday afternoon, a time when the government often reports unfavorable developments.
Eager to maximize coverage under the Affordable Care Act, the Obama administration has allowed large numbers of people to sign up for insurance after the deadlines in the last two years, destabilizing insurance markets and driving up premiums, health insurance companies say.
The administration has created more than 30 “special enrollment” categories and sent emails to millions of Americans last year urging them to see if they might be able to sign up after the annual open enrollment deadline. But, insurers and state officials said, the federal government did little to verify whether late arrivals were eligible.
In most states, health insurance premiums on the individual marketplace are rising by double digits under Obamacare. 17 states will face average premium increases of 20% or more. Iowans, for instance, will see their premiums spike by 22% this year. In Minnesota, Alaska, Tennessee, and Hawaii, rates will rise by 30% or more.
Want to know where your state ranks? FreedomWorks has calculated the average rate hike and the range of premium changes individuals purchasing insurance on the individual market will face. Click below to read more.
Recently, the Obama administration said 11.3 million Americans had signed up for 2016 health exchange plans by late December.
“That’s still significantly lower than what experts had initially expected at this point in time in exchange implementation,” said Caroline Pearson, senior vice president with health care consulting firm Avalere. “We had anticipated, based on the Congressional Budget Office estimates, that perhaps 21 million people might be enrolled in 2016.”
“Many middle income people continue to suggest that exchange plans just aren’t affordable for them,” Pearson told CNBC. “Even with the subsidies, they simply can’t make the monthly premiums work in addition to all of the out of pocket costs.”
The Obama administration so far is making little progress in getting more young adults to sign up for health policies on the federal insurance exchange, according to figures released Thursday.
26% of people who signed up for coverage as of Dec. 26 in the 38 states that use the federal exchange were ages 18 to 34, according to a report from the Centers for Medicare and Medicaid Services, which administers the law. That figure is largely unchanged from a roughly comparable two-month period through Jan. 16, 2015.